First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
Neural Plast. 2022 Apr 21;2022:5635596. doi: 10.1155/2022/5635596. eCollection 2022.
Aphasia is a common symptom in stroke patients, presenting with the impairment of spontaneous speech, repetition, naming, auditory comprehension, reading, and writing function. Multiple rehabilitation methods have been suggested for the recovery of poststroke aphasia, including medication treatment, behavioral therapy, and stimulation approach. Acupuncture has been proven to have a beneficial effect on improving speech functions in repetition, oral speech, reading, comprehension, and writing ability. Neuroimaging technology provides a visualized way to explore cerebral neural activity, which helps reveal the therapeutic effect of acupuncture therapy. In this systematic review, we aim to reveal and summarize the neuroimaging mechanism of acupuncture therapy on poststroke aphasia to provide the foundation for further study.
Seven electronic databases were searched including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, the Wanfang databases, and the Chinese Scientific Journal Database. After screening the studies according to the inclusion and exclusion criteria, we summarized the neuroimaging mechanism of acupuncture on poststroke aphasia, as well as the utilization of acupuncture therapy and the methodological characteristics.
After searching, 885 articles were retrieved. After removing the literature studies, animal studies, and case reports, 16 studies were included in the final analysis. For the acupuncture type, 10 studies used manual acupuncture and 5 studies used electroacupuncture, while body acupuncture (10 studies), scalp acupuncture (7 studies), and tongue acupuncture (8 studies) were applied for poststroke aphasia patients. Based on blood oxygen level-dependent (BOLD) and diffusion tensor imaging (DTI) technologies, 4 neuroimaging analysis methods were used including amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), seed-based analysis, and independent component analysis (ICA). Two studies reported the instant acupuncture effect, and 14 studies reported the constant acupuncture's effect on poststroke aphasia patients. 5 studies analyzed the correlation between the neuroimaging outcomes and the clinical language scales.
In this systematic review, we found that the mechanism of acupuncture's effect might be associated with the activation and functional connectivity of language-related brain areas, such as brain areas around Broca's area and Wernicke's area in the left inferior temporal gyrus, supramarginal gyrus, middle frontal gyrus, and inferior frontal gyrus. However, these studies were still in the preliminary stage. Multicenter randomized controlled trials (RCT) with large sample sizes were needed to verify current evidence, as well as to explore deeply the neuroimaging mechanisms of acupuncture's effects.
失语症是脑卒中患者的常见症状，表现为自发性言语、复述、命名、听觉理解、阅读和书写功能障碍。针对脑卒中后失语症的康复，已经提出了多种康复方法，包括药物治疗、行为疗法和刺激方法。针灸已被证明对改善重复、口语、阅读、理解和书写能力的言语功能有有益的效果。神经影像学技术为探索大脑神经活动提供了一种可视化的方法，有助于揭示针灸治疗的疗效。在这项系统评价中，我们旨在揭示和总结针灸治疗脑卒中后失语症的神经影像学机制，为进一步研究提供基础。
检索了 PubMed、Web of Science、Embase、Cochrane 中央对照试验注册库、中国知网、万方数据库和中国科学期刊数据库等 7 个电子数据库。根据纳入和排除标准筛选研究后，我们总结了针灸治疗脑卒中后失语症的神经影像学机制，以及针灸治疗的应用和方法学特点。
搜索后共检索到 885 篇文章，去除文献研究、动物研究和病例报告后，最终纳入 16 项研究。针对针灸类型，10 项研究采用手动针灸，5 项研究采用电针，而脑卒中后失语症患者则采用体针（10 项研究）、头针（7 项研究）和舌针（8 项研究）。基于血氧水平依赖（BOLD）和弥散张量成像（DTI）技术，使用了 4 种神经影像学分析方法，包括低频振幅（ALFF）、局部一致性（ReHo）、种子分析和独立成分分析（ICA）。有 2 项研究报告了即时针灸效果，14 项研究报告了常规针灸对脑卒中后失语症患者的效果。有 5 项研究分析了神经影像学结果与临床语言量表之间的相关性。
在这项系统评价中，我们发现针灸效应的机制可能与语言相关脑区的激活和功能连接有关，如左颞下回的布罗卡区和韦尼克区周围脑区、缘上回、额中回和额下回。然而，这些研究仍处于初步阶段。需要进行多中心大样本随机对照试验（RCT）来验证现有证据，并深入探讨针灸疗效的神经影像学机制。
